Knowledge about tuberculosis transmission and prevention and perceptions of health service utilization among index cases and contacts in Brazil: Understanding losses in the latent tuberculosis cascade of care.

Flavia Matos Salame,Eleny Guimarães Teixeira,Marcia Teresa Belo,Márcia Danielle Ferreira,Philip C Hill,Dick Menzies,Ricardo Arraes Ximenes,Anete Trajman,Marcelo Cordeiro-Santos,Maria De Fátima Militão De Albuquerque,Seyed Ehtesham Hasnain

doi:10.1371/journal.pone.0184061

Abstract

IntroductionTuberculosis contacts are candidates for active and latent tuberculosis infection screening and eventual treatment. However, many losses occur in the different steps of the contacts’ cascade of care. Reasons for this are poorly understood.ObjectiveTo describe the different steps where losses in the contact cascade occur and to explore knowledge and attitudes regarding tuberculosis transmission/prevention and perceptions about tuberculosis services in order to understand the reasons for losses from the tuberculosis service users’ perspective.DesignWe collected routine data from the index case and contact registry books and from patients’ records to build the cascade of care of contacts in 12 health facilities in three Brazilian cities with high tuberculosis incidence rates. During a knowledge, attitudes and practices (KAP) survey, trained interviewers administered a semi-structured questionnaire to 138 index cases and 98 contacts.ResultsMost of the losses in the cascade occurred in the first two steps (contact identification, 43% and tuberculin skin testing placement, 91% of the identified contacts). Among KAP-interviewed contacts, 67% knew how tuberculosis is transmitted, 87% knew its key symptoms and 81% declared they would take preventive therapy if prescribed. Among KAP-interviewed index cases, 67% knew they could spread tuberculosis, 70% feared for the health of their families and 88% would like their family to be evaluated in the same services.ConclusionOnly a small proportion of contacts are evaluated for active and latent tuberculosis, despite their—and their index cases’—reasonable knowledge, positive attitudes towards prevention and satisfaction with tuberculosis services. In these services, education of service users would not be a sufficient solution. Healthcare workers’ and managers’ perspective, not explored in this study, may bring more light to this subject.

Highlights

Tuberculosis contacts are candidates for active and latent tuberculosis infection screening and eventual treatment
Contact investigation helps to identify active TB disease and latent Mycobacterium tuberculosis infection (LTBI) in contacts.[3]. Those with LTBI are at high risk for progression to active disease, they are an important reservoir for new TB cases.[4]
Among 138 index cases and 100 contacts across the three sites on the designated survey days, only two contacts refused to participate in the study

Summary

Methods

We used a Knowledge, Attitudes and Practice (KAP) design, a representative study of a specific population to collect information on what is known, believed (attitudes) and done (practice) in relation to a particular topic.[25,26], In most KAP studies, data are collected by an interviewer using a structured, standardized questionnaire. These data can be analyzed in a quantitative or qualitative format, according to research objectives.

Results

Discussion

Conclusion